Why Doesn’t Medicare Cover Annual Physicals?
Understand why Medicare's approach to preventive care means it doesn't cover a traditional annual physical and what your options are.
Many people enrolling in Medicare are surprised to learn it generally does not cover a standard annual physical examination. This can cause confusion, as a yearly check-up is common for maintaining health. Medicare operates with a distinct philosophy concerning preventive care, differing significantly from comprehensive annual physicals offered by other insurance plans. The program emphasizes specific preventive services to identify potential health issues early, rather than a broad, hands-on physical assessment.
Medicare’s Approach to Preventive Care
Original Medicare Part B does not cover a comprehensive “annual physical.” Instead, it focuses on specific preventive services designed to detect health problems early or prevent their development. This approach includes two distinct types of visits: the “Welcome to Medicare” preventive visit and the “Annual Wellness Visit.”
The “Welcome to Medicare” preventive visit is a one-time benefit available within the first 12 months of enrolling in Medicare Part B. During this visit, a healthcare provider reviews your medical and social history, measures your height, weight, blood pressure, and body mass index, and performs a simple vision test. It also includes a health risk assessment and personalized prevention plan development, but is not a head-to-toe physical exam. This visit typically does not include lab tests unless medically necessary for a specific concern.
After the initial 12 months of Part B enrollment, beneficiaries become eligible for an “Annual Wellness Visit” (AWV) once every 12 months. This visit’s primary purpose is to develop or update a personalized prevention plan based on your current health and risk factors. It includes a health risk assessment, a review of your medical and family history, and a cognitive assessment for signs of dementia. This visit does not involve a physical examination or routine lab tests; its focus is on health planning and prevention rather than diagnosing existing conditions.
Components of a Traditional Annual Physical
A traditional annual physical examination typically involves a more extensive, hands-on assessment than Medicare’s preventive visits. During this appointment, a healthcare provider conducts a thorough physical examination of various body systems. This includes listening to your heart and lungs, palpating the abdomen, checking reflexes, and examining the head, neck, and skin.
Beyond the physical examination, a traditional annual physical often includes routine blood work to screen for various conditions. These tests might check cholesterol levels, blood sugar, and a complete blood count. Urine tests may also be part of routine screening. The visit also allows for detailed discussions about any new symptoms or specific health concerns.
Other Avenues for Coverage
While Original Medicare (Parts A and B) generally does not cover traditional annual physicals, alternative avenues exist for individuals to obtain such coverage. Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies and are a common option. These plans are required to cover all benefits provided by Original Medicare, but often include additional benefits, which can encompass coverage for a traditional annual physical examination.
Beneficiaries enrolled in a Medicare Advantage plan should review their specific plan’s benefits, as coverage for annual physicals can vary significantly. Original Medicare Part B does not cover routine physicals, but it does cover specific diagnostic tests and screenings if medically necessary for a particular condition. These medically indicated tests are distinct from general, non-problem-focused screenings that might be part of a routine annual physical.